Table1_Shared decision making and medication adherence in patients with COPD and/or asthma: the ANANAS study.DOCX

Background: Medication adherence to inhalation medication is suboptimal in patients with COPD and asthma. Shared decision making (SDM) is proposed as an intervention to improve medication adherence. Despite its wide promotion, evidence of SDM’s association with greater medication adherence is scarce. Also, it is unknown to what degree patients presently experience SDM and how it is associated with medication adherence.Objective: To (i) assess the level of SDM and (ii) medication adherence, (iii) explore the relation between SDM and medication adherence and iv) investigate possible underlying mechanisms.Methods: Cross-sectional observational study. A survey was distributed among Dutch patients with COPD and/or asthma using inhaled medication. Medication adherence was measured using the Test of Adherence to Inhalers (TAI-10), and SDM by the 9-item Shared Decision-Making questionnaire (SMD-Q-9). Feeling of competence, relatedness and feeling of autonomy from the Self-Determination Theory (SDT) were considered as possible mechanisms. The primary outcome was adherence.Results: A total of 396 patients with complete information on relevant covariates were included. Mean SDM-Q-9 score was 26.7 (SD 12.1, range 0–45) and complete adherence was 41.2%. The odds ratio for the association of SDM with adherence was 1.01 (95% CI: 0.99, 1.02). This only changed minimally when adjusted for mediators (mediating effect

背景：慢性阻塞性肺疾病（COPD）和哮喘患者对吸入性药物的依从性普遍不佳。共同决策（SDM）被提议作为一种干预措施以改善药物依从性。尽管其被广泛推广，但关于SDM与更高药物依从性之间关联的证据却寥寥无几。此外，目前尚不清楚患者目前体验到SDM的程度以及它与药物依从性的关联程度。目标：（i）评估SDM和药物依从性的水平，（ii）探讨SDM与药物依从性之间的关系，（iii）探究可能的潜在机制。方法：横断面观察性研究。对使用吸入性药物的荷兰COPD和/或哮喘患者进行了问卷调查。药物依从性通过吸入器依从性测试（TAI-10）进行测量，SDM通过9项共同决策问卷（SMD-Q-9）进行评估。根据自我决定理论（SDT），能力感、关联感和自主感被视为可能的机制。主要结果指标为依从性。结果：共有396名患者在相关协变量方面的信息完整，SDM-Q-9的平均得分为26.7（标准差12.1，范围0-45），完全依从率为41.2%。SDM与依从性关联的比值比（OR）为1.01（95% CI：0.99，1.02）。在调整了中介变量后，这一结果仅发生了微小的变化。